For the five year period ending December 31, 2008, the Empire Plan paid 169,912 claims totaling $249.7 million for services provided by Stony Brook to Plan members. Auditors identified 94 errors (44 percent) on 79 of the 179 random sample claims, which led to overpayments. When auditors statistically projected these errors, the resulting estimate showed that the hospital had been overpaid by $3.7 million. Auditors recommended that the carrier recover these overpayments and establish controls to prevent future overpayments.

Department of Civil Service, New York State Health Insurance Program: Payments Made to Hudson Valley Hospital Center (2009-S-99)
Auditors examined reimbursement payments made to Hudson Valley Hospital Center, over three years ending December 31, 2009. Weaknesses found in the agreement between the carrier and the hospital’s parent organization resulted in excessive payments for services. The carrier paid the hospital a total of $1.1 million for the services that cost the hospital $228,153 to provide. Under the agreement, the excessive payments could not be recovered. Auditors recommended modifications to prevent future excessive payments.

Higher Education Services Corporation - Tuition Assistance Program (TAP), Long Island Business Institute (2009-T-6)
For the three academic years ending June 30, 2008, LIBI officials certified 4,863 TAP awards totaling more than $10.3 million. Auditors disallowed $7,500 of this amount because school officials incorrectly certified three students as eligible for four TAP awards. Two of the students received three awards even though they had not met matriculation requirements. The other student was not in good academic standing and, therefore, not eligible for a TAP award.

New York City Health and Hospitals Corporation, Affiliation Agreement with the State University of New York Downstate Medical Center (2010-F-32)
New York City Health and Hospitals Corporation (HHC) has an affiliation agreement between its Kings County Hospital Center and the State University of New York Downstate Medical Center. The agreement requires Downstate Medical Center to provide Kings County Hospital with a certain number of full-time equivalent physicians and can be reimbursed up to $15.7 million annually for their services. In audit report 2006-N-19, auditors examined these reimbursements and found that Downstate Medical Center was providing the physicians required and that their time worked was supported by time records. However, auditors found these services were not being reimbursed in full accordance with the agreement. When followed up on, they found progress had been made.

New York City Human Resources Administration, Personal and Miscellaneous Service Contracts (2010-N-3)
During the period July 2008 through November 2009, the New York City Human Resources Administration had 386 personal and miscellaneous service contracts in place with a total value of $423 million. Auditors examined whether the administration was adequately justifying the need to initially contract out for services and periodically reassessing whether contracts could be deferred, eliminated or reduced. Auditors found that this was not being done and recommended improvements in the administration of contracts.

New York City Department of Health and Mental Hygiene, Contracts for Personal and Miscellaneous Services (2009-N-14)
During the period July 2008 through November 2009, the New York City Department of Health and Mental Hygiene had 212 personal and miscellaneous service contracts, with a total value of $106 million. Auditors examined whether the department was adequately justifying the need to initially contract out for such services and periodically reassessing whether contracts could be deferred, eliminated or reduced. They found that the department used a standardized form to identify the reasons for contracting out services. However, they could not provide documentation to support these reasons. Auditors also determined that the department was not periodically reassessing contracts and recommended improvements.

For the three academic years that ended June 30, 2008, the New York Institute of Technology certified more than $15.4 million in TAP awards. Auditors tested the accuracy of the awards and disallowed $109,380. They also disallowed four awards totaling $5,450 because students were either not in full-time attendance or not in good academic standing. In total, auditors disallowed $114,830 and recommended that HESC recover the total plus applicable interest.